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Spontaneous Coronary Artery Dissection after Minimally Invasive Mitral Valve Repair

Mirko Muretti1, Mario Manca1, Francesco Massi1

  • 1Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy.

The Heart Surgery Forum
|November 2, 2016
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) is rare, often affecting young women. This case highlights SCAD occurring post-minimally invasive mitral valve repair, necessitating emergency bypass surgery.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Cardiac Surgery

Background:

  • Spontaneous coronary artery dissection (SCAD) is a rare condition, typically affecting young women without traditional atherosclerotic risk factors.
  • SCAD is often associated with tortuous coronary arteries or fibromuscular dysplasia.
  • While less common, SCAD can occur in patients with underlying atherosclerotic disease.

Observation:

  • A patient undergoing minimally invasive mitral valve repair experienced an uneventful postoperative course initially.
  • The patient subsequently developed spontaneous coronary artery dissection of the left main coronary artery.
  • This complication led to a life-threatening condition requiring immediate intervention.

Findings:

  • Minimally invasive cardiac surgery can precipitate spontaneous coronary artery dissection, even in the absence of typical SCAD risk factors.
  • Left main coronary artery dissection presents as a critical surgical emergency.
  • Prompt diagnosis and intervention are crucial for managing SCAD post-cardiac surgery.

Implications:

  • Cardiac surgeons should maintain a high index of suspicion for SCAD in patients with new-onset ischemic symptoms after cardiac procedures.
  • Minimally invasive techniques may require specific considerations to mitigate SCAD risk.
  • Emergency coronary artery bypass grafting is a viable treatment for life-threatening SCAD following cardiac surgery.

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